The future we want is a healthy
one. Better health contributes to
sustainable development simply
because healthy people are better
able to learn, earn and contribute
positively to their societies. This
was well captured in the original Rio
Declaration in 1992 where Principle
1 speaks of “human beings as
the central concern of sustainable
development…living a healthy and
productive life in harmony with
nature”. The role of health was
reaffirmed at the Johannesburg
summit ten years later and is even
more vital today. I believe that in
2012 we need to make the case for
health more strongly, and we have
the evidence to do so.

We need to start thinking about the
relationship between health and
sustainable development in three
complementary ways. Health as
a contributor to the achievement
of sustainability goals; health as a
potential beneficiary of sustainable
development; and health as a way
of measuring progress across
all three pillars of sustainable
development policy.

Let’s start with the last point.
Progress towards sustainable
development requires metrics
that integrate the economic,
environmental and social dimensions
of policy. Investment in health
alone cannot solve the problems
of sovereign debt, volatile food
prices or the environmental impact
of climate change. But for those of
us that are concerned to promote a
fairer, greener and more sustainable
approach to globalisation, people’s
health remains vitally important as
a measure of the impact of policies
in all these areas. Not only are
health outcomes readily measurable,
health concerns are immediate,
personal and local. Measuring the
impact of sustainable development
on health can therefore generate
public and political interest in a
way that builds popular support
for policies that have more diffuse
or deferred outcomes (such as
reducing CO2 emissions).

A healthy environment is a
prerequisite for good health.
Reductions in air, water and
chemical pollution can prevent up
to one quarter of the overall burden
of disease. Environmental change
(through deforestation, air pollution,
desertification, urbanisation and
changing land use) have been
causally linked to many pressing
global health problems — including
malaria, water-borne diseases,
malnutrition, AIDS , TB, maternal
health and non-communicable
diseases (such as cancer, heart
disease, chronic respiratory disease
and diabetes). But while health can
be a major beneficiary of economic
and environmental development, this
will not happen automatically. Twenty
years after the first Rio Summit,
decisions that guide urban planning,
transport and housing development
too often still create rather than
reduce air pollution, noise and
traffic injuries, and limit rather than
promote physical activity. Agricultural
and food policies too often make
it harder, not easier to access to
healthy and nutritious foods.

Evidence shows we can do things
differently. WHO’s Health in the
Green Economy series points to
many examples. Studies of active
transport systems show that cycling
to work can reduce mortality
by 30 per cent. Access to rapid
transit systems also goes hand in
hand with more equitable health
outcomes because people are
better able to access the services
they need. The right mix of climate
change mitigation policies for
residential buildings can contribute
to a reduction in health risks
from extreme weather conditions.
Energy policies that reduce air
pollution could halve the number of
childhood deaths from pneumonia
and substantially reduce the one
million deaths each year that occur
from chronic lung disease. Cleaner
cooking fuels are particularly
important: current evidence
suggests that replacing biomass or
coal stoves with cleaner fuels can
help improve the health of up to
three billion people.

We often refer to the health
co-benefits of environmental
policies and the need to multiply the
health dividends from sustainable
development, but essentially what
we are talking about is a need for
policy coherence. As the world
seeks to address the challenges
posed by ageing populations,
growing cities, increasingly mobile
populations, competition for
scarce natural resources, financial
uncertainty, and the vagaries of a
changing climate, it is no longer viable to think of solutions in terms
of individual sectors. Similarly, there
is little to be gained by policies
(such as scaling up the use of diesel
fuel) that reduce greenhouse gas
emissions, but risk increasing levels
of respiratory or cardiac disease
as a result of air pollution. A green
economy is one that maximises
benefits, but with health and human
well-being as the bottom line.

Lastly, there is the specific
contribution that health policy can
make to sustainable development.
WHO estimates that 150 million
people each year suffer severe
financial hardship because they fall
ill, use health services and have
to pay for them on the spot. Many
have to sell assets or go into debt
to meet the payments. A hundred
million people are pushed below the
poverty line for these reasons. The
links between health, sustainable
development and economic growth
become starkly clear when we
realise that lack of access to health
services impoverishes people
because they cannot work, while
using health services impoverishes
people because they cannot pay.

Protecting people from catastrophic
expenditure and ensuring access
to essential services (including
reproductive and sexual health
services) through Universal Health
Coverage is an essential element
of any strategy to reduce poverty
and build resilient societies.
From this perspective, health is
not just a desirable side effect
or co-beneficiary of sustainable
development. Rather, it needs to
be seen as an essential pillar in
its own right — with potential to
increase economic growth, improve
educational opportunities, limit
the negative impact of population
growth, reduce impoverishment and
foster social cohesion.